Evaluation of treatment access and scope of a multistate hepatitis C virus Extension for Community Healthcare Outcomes telehealth service in the US Indian Health System, 2017-2021.

PURPOSE: American Indians/Alaska Native (AI/AN) persons are disproportionately affected by hepatitis C virus (HCV). The Northwest Portland Area Indian Health Board Indian Country Extension for Community Healthcare Outcomes (ECHO) telehealth clinic supports primary care providers (PCPs) in treating HCV. We evaluated the extent to which Indian Country ECHO increases access to HCV treatment and holistically serves AI/AN patients. METHODS: We conducted a retrospective descriptive analysis of Indian Country ECHO treatment recommendations from 2017 to 2021. Recommendations were classified into the following categories: HCV treatment with direct-acting antiviral medication, prevention, substance use disorder treatment, lab or imaging orders, pharmacological considerations, behavior changes, other, and referral. Subanalysis of treatment recommendations was completed for patients with cirrhosis. FINDINGS: Of the 776 patients from 77 Indian Health System facilities who presented at Indian Country ECHO, 718 (93%) received treatment recommendations. Most patients (93%) received recommendations for HCV treatment by their PCP; only 3% received a recommendation for referral to a hepatologist or liver transplant center for additional care. Most patients received at least 1 recommendation beyond the scope of HCV treatment provision. Cirrhosis criteria were met by 8% of patients, of which 80% received recommendations for HCV treatment by their PCP and 25% received recommendations for referral to a specialist for additional care. CONCLUSIONS: Most patients presented at the Indian Country ECHO received recommendations for HCV treatment by their PCP, along with recommendations beyond the scope of HCV. Indian Country ECHO telehealth clinic provides comprehensive recommendations to effectively integrate evidence-based HCV treatment with holistic care at the primary care level.

Alaska Native and rural youth views of sexual health: a focus group project on sexually transmitted diseases, HIV/AIDS, and unplanned pregnancy.

BACKGROUND: The disparity in rates of sexually transmitted diseases (STDs), HIV/AIDS, and unplanned pregnancy between Alaska Native (AN) and non-AN populations, particularly among young adults and females, is significant and concerning. Focus groups were conducted to better understand the knowledge, attitudes, and beliefs of rural Alaska youth (both AN and non-AN) and communities regarding STDs, HIV/AIDS, and unplanned pregnancy and to determine the best methods to educate and facilitate behavior change in AN youth regarding these issues. METHODS: A convenience sample of AN and rural youth (n = 105) from 5 communities in Alaska, ages 15-24 years, participated in 21 focus groups. Focus group participants were divided by sex and age. We assessed themes related to knowledge, attitudes, and beliefs about STDs, HIV/AIDS, and unplanned pregnancy, as well as perceptions of how youth prefer to learn about sexual health issues. RESULTS: The major themes identified were: (1) sexual health is not viewed only in relation to a physical act; (2) there is a basic understanding of sexual health, but youth have a lot of unanswered questions pertaining to STDs and HIV/AIDS; (3) sexual health messages should be delivered via the Internet and school; (4) youth want to hear messages promoting STD/HIV testing and condom use; (5) easier access to condoms is needed; (6) alcohol and drug use affect sexual behavior and risk taking; and (7) issues of confidentiality and embarrassment affect health care-seeking behaviors for sexual health issues. CONCLUSIONS: One of the fundamental principles of public health practice is community participation, which asserts that success in achieving change is enhanced by the active participation of the intended audience in defining their own high-priority solutions. Our findings-driven by youth themselves-are critical in designing and implementing future sexual health interventions and promoting greater community involvement and acceptance.

Visual impairment and eye care among Alaska Native people.

PURPOSE: To estimate the prevalence of visual impairment, eye disease and eye care in the Alaska Native (AN) population, by demographic and socioeconomic factors. METHODS: Population-based cross-sectional study of 3,793 AN adults aged 18-94 years enrolled in the Education and Research Towards Health (EARTH) Study from March 2004-March 2006. Data on self-reported visual impairment, cataract, glaucoma, diabetic eye disease and previous dilated eye examinations were collected using audio computer-assisted self-administered questionnaires. RESULTS: The unadjusted prevalence of self-reported visual impairment was 8.7% (95% confidence interval (CI): 7.9-9.7), cataract 5.9% (95% CI: 5.2-6.7), glaucoma 2.5% (95% CI: 2.0-3.0) and diabetic eye disease 1.3% (95% CI: 0.9-1.7). In all cases, age-sex adjusted prevalence estimates for the AN population were greater than available estimates for the general U.S. population. Prevalence of visual impairment and each eye disease increased with age (P < 0.01). Additional factors associated with visual impairment were education and annual household income. Overall, 70.0% (95% CI: 68.5-71.6) of participants reported a dilated eye examination within the previous two years. Dilated eye examination within the previous two years was associated with increasing age (P < 0.001). However, men and participants with lower formal education were less likely to report recent dilated eye examination. Among those with diabetes, only 67.7% (95% CI: 60.8-74.1) reported a dilated eye examination within the recommended previous one year. CONCLUSIONS: Self-reported visual impairment, cataract, glaucoma and diabetic eye disease are prevalent in the AN population. These data may be useful in healthcare planning and education programs.